The Management of Acute Cholecystitis in Elderly Patients: Percutaneous Cholecystostomy versus Cholecystectomy

Abstract

Objective: Treatment of acute cholecystitis in eldery patients still remains controversial. Because of advanced age that can influence surgical results, less invasive managements have been performed in this population. The goal of this study was to analyze the results of cholecystectomy versus percutaneous cholecystostomy for acute cholecystitis in elderly patients. Material and Method: Seventy four patients aged 65 years and older treated for acute cholecystitis were identified retrospectively from our medical records. Results: Of the 74 patients, 40 (54 %) underwent cholecystectomy, while 34 (46%) had a percutaneous cholecystostomy for AC as an initial treatment. The mean length of follow up was 28, 5±29, 3(1-35) months in percutaneous cholecystostomy and 12, 4±15 (1-42) months in cholecystectomy patients, respectively (p=0,0032). The success rate was significantly higher in cholecystectomy patients compared to percutaneous cholecystostomy patients (p=0,0210). Seventeen (50 %) patients who had PC subsequently underwent cholecystectomy. Readmission rates were higher in the percutaneous cholecystostomy group (p=0, 0848). There was no statistically significant difference in the patient survival rate between the two groups (p=0,1799). Conclusion: This study confirms that cholecystectomy is a more effective treatment than percutaneous cholecystostomy for acute cholecystitis in elderly patient who is fit for surgery.

Keywords

• Acute cholecystitis, Elderly, Percutaneous cholecystostomy, Cholecystectomy.

Yaşlılarda Akut Kolesistit Tedavisine Yaklaşım: Perkütan Kolesistostomi veya Kolesistektomi

Öz

Amaç: Yaşlılarda akut kolesistitin tedavisi hala tartışılan bir konudur. İleri yaşın cerrahi sonuçlar üzerindeki etkisi nedeni ile bu hastalarda daha az invaziv yöntemler bir seçenek olarak uygulanmaktadır. Bu çalışmada yaşlılarda akut kolesistit tedavisinde uygulanan kolesistektomi ile perkütan kolesistostominin sonuçları karşılaştırıldı. Gereç ve Yöntem: Akut kolesistit nedeni ile tedavi gören 65 yaş ve üzerindeki 74 hastanın dosyası geriye dönük olarak incelendi. Bulgular: Yetmiş dört hastadan, 40 (% 54) tanesi kolesistektomi ile 34 hasta ise perkütan kolesistostomi ile tedavi edildi. Ortalama takip süresi perkütan kolesistostomi grubunda 28,5±29,3 ( 1-35) ay, buna karşın kolesistektomi grubunda 12, 4±15 (1-42) aydı (p=0,0032). Tedavide başarı oranı kolesistektomi grubunda daha yüksekti ve bu farklılık istatistiksel olarak anlamlı idi (p=0,0210). Perkütan kolesistostomi yapılan hastaların on yedisi (%50) zamanla kolesistektomi ameliyatı oldu.Taburcu sonrası şikayetle hastaneye tekrar başvuru oranı perkütan kolesistostomi hastalarında daha yüksekti (p=0,0848). Her ne kadar perkütan kolesistostomi grubu hastalarında akut kolesistit'e bağlı ölüm oranı daha yüksek görülse de istatistiksel anlamda önemli bir farklılık görülmedi (p=0,1799). Sonuç: Bu çalışmada, yaşlılarda akut kolesistit tedavisinde kolesistektominin cerrahiye uygun hastalarda perkütan kolesistostomiden daha etkili bir tedavi yöntemi olduğunu gösterildi.

Anahtar Kelimeler

• Akut kolesistit, Yaşlılar, Perkütan kolesistostomi, Kolesistektomi.

References

1. Greengross S, Murphy E, Quam L, et al. Aging: a subject that must be at the top of world agendas. BMJ 1997; 315: 1029–30.
2. Indar AA, Beckingham IJ. Acute cholecystitis. BMJ 2002; 325: 639-43.
3. NIH consensus statement on gallstones and laparoscopic cholecystectomy. National Institutes of Health Consensus Development Conference Statement 1992; 14-6.
4. Halldestam I, Enell EL, Kullman E, Borch K. Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg 2004; 91: 734-8.
5. Spira RM, Nissan A, Zamir O, at al. Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis. Am J Surg 2002; 183: 62-6.
6. Melloul E, Denys A, Demartines N, Calmes M, Schafer M. Percutaneous drainage versus emergency cholecystectomy for the treatment of acute cholecystitis in critically ill patients: Does it Matter? World J Surg 2011; 35: 826-33.
7. Siegel JH, Kasmin FE. Biliary tract diseases in the elderly: management and outcomes. Gut 1997; 41: 433-5
8. Sugiyama M, Tokuhara M, Atomi Y. Is percutaneous cholecystostomy the optimal treatment for acute cholecystitis in the very elderly? World J Surg 1998; 22: 459-63.

9. Klimberg S, Hawkins I, Vogel SB. Percutaneous cholecystostomy for acute cholecystitis in high-risk patients. Am J Surg 1987; 153: 125-9.
10. Kortram K, Vries Reilingh TS, Wiezer MJ, Ramshorst B, Boerma D. Percutaneous drainage for acute calculous cholecystitis. Surg Endosc 2011; 25: 3642-6.
11. Griniatsos J, Petrou A, Pappas P, et al. Percutaneous cholecystostomy without interval cholecystectomy as definitive treatment of acute cholecystitis in elderly and critically ill patients. South Med J 2008; 101: 586-90.
12. Byrne MF, Suhocki P, Mitchell RM, et al. Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center. J Am Coll Surg 2003; 197: 206-11.
13. Winbladh A, Gullstrand P, Svanvik J, et al. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford) 2009; 11: 183-93.
14. Macri A, Scuderi G, Saladino E, et al. Acute gallstone cholecystitis in the elderly: treatment with emergency ultrasonographic percutaneous cholecystostomy and interval laparoscopic cholecystectomy. Surg Endosc 2006; 20: 88-91.
15. Siddiqui T, MacDonald A, Chong PS. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis of randomized clinical trials. Am J Surg 2008; 195: 40
16. Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev 2006; 4: CD006231.
17. Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 2010; 97: 141
18. Chandler CF, Lane JS, Ferguson P, et al. Prospective evaluation of early vs delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg 2000; 66: 896-900.